CADE condemns medical classes for price fixing

Condemnation

In total, the imposed fines totalize approximately BRL 383,000

published:
Mar 12, 2015 11:00 AMlast modified:
Apr 11, 2016 03:54 PM

The Administrative Council for Economic Defense – CADE condemned on the judgment session of 11 March 2015, the Regional Medical Council of São Paulo (CREMESP), the São Paulo Association of Medicine (APM), and the Union of Medical Doctors of São Paulo (SIMESP) for fixing prices of medical and hospital services in the healthcare market. In total, the imposed fines totalize approximately BRL 383,000 (Administrative Proceeding no. 08012.006647/2004-50).

The condemned conduct was held in 2004. At the occasion, CREMESP, APM, and SIMESP imposed to the health plan operators the Brazilian Hierarchical Classification of Medical Procedures (CBHPM for its acronym in Portuguese), which is a table of minimum prices for doctor’s fees, and hospital procedures and examinations. In 30 July 2004, doctors from São Paulo decided to suspend, indefinitely, all the services provided to the health plans that rejected the table as a price reference.

After the boycotts, the affected plan beneficiaries started to use a refund system. They needed to pay BRL 42, the reference price for the procedures, for each consult to be, then, reimbursed by the health plan operators.

According to Reporting Commissioner Gilvandro Araújo, the classes imposed the CBHPM table as a mandatory table and, thus, formed in the market a block impervious to competition, since doctors could that did not follow the imposed rules by the table were subjected to ethical disciplinary procedures. On the other hand, the health plan operators were threatened to have their accreditation cancelled collectively if they did not accept the conditions imposed unilaterally.

In addition to the fines, CADE’s Tribunal determined that CREMESP, APM, and SIMESP must stop the imposition of price tables, the promotion of boycotts and interruptions to health plans’ services, and to oblige doctors to adopt the established table under the threat of disciplinary investigation. If the conduct persists, a daily fine of BRL 5,300 was established.

Minas Gerais

On 11 March 2015, CADE’s Tribunal also condemned the Medical Association of Divinópolis – AMD, and Unimed Divinópolis for fixing a minimum price table for doctor’s fees, based in the same CBHPM table. Both classes were condemned to the payment of a BRL 63,800 fine for each (Administrative Proceeding no. 08012.00432/2005-14).

In the city of Divinópolis, in Minas Gerais, the imposition of the prices in the CBHPM table also happened in 2004. Reporting Commissioner Gilvandro Araújo explained that AMD imposed to health plan operator the adoption of the table under the threat of collectively canceling their accreditation. In the same way, Unimed Divinópolis forced its doctors to adopt the table under the threat to expel them cooperative.

CADE’s Tribunal determined, in addition, that both classes must stop to implement tables and/or to promote collective negotiations in which the main objective is to standardize the prices and/or conditions to the medical services’ provision. Furthermore, they must cease to promote, support or encourage boycotts and interruptions in the provision of services to the health plans beneficiaries or loss of accreditation.